Provider Demographics
NPI:1033791363
Name:JONIAK, KRISTEN BEATRICE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BEATRICE
Last Name:JONIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8702 HUNTERS LAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2855
Mailing Address - Country:US
Mailing Address - Phone:813-467-4700
Mailing Address - Fax:813-467-4261
Practice Address - Street 1:8702 HUNTERS LAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2855
Practice Address - Country:US
Practice Address - Phone:813-467-4700
Practice Address - Fax:813-467-4261
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010779363LF0000X
FLAPRN11010779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110791800Medicaid
FL6ACQ4OtherBCBS